Basic Information
| Provider Information | |||||||||
| NPI: | 1336715549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARY | ||||||||
| FirstName: | SETH | ||||||||
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| Credential: | DNP, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 494 HUB BLVD APT 1422 | ||||||||
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| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421038939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707992210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707451000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2021 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 133571 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.